Justia Public Benefits Opinion Summaries

After the Department of Education issued a proposed determination that Texas was ineligible for $33.3 million of future grants because of the shortfall in both aggregate and per capita state funding, the state argued that it had complied with the "maintenance of state financial support" (MFS) requirement because funding under a weighted-student model had remained constant.The Fifth Circuit denied Texas' petition for review and held that the weighted-student model contravenes the plain meaning of the MFS clause. The court explained that, under the weighted-student model, Texas may reduce the amount of funding for special education if it determines that the needs of children with disabilities have changed. In this case, Texas violated the plain requirements of the MFS clause by doing so and was therefore ineligible for the corresponding amount of future Individuals and Disabilities Education Act Part B grants. Finally, the MFS clause did not exceed Congress's spending power by failing to provide sufficiently clear notice of its requirements. View "Texas Education Agency v. United States Department of Education" on Justia Law

Ashby’s son was a member of his elementary school choir. In 2014 and 2015, the choir performed a Christmas concert at a local museum in a historic building. The building was not then accessible to persons with disabilities. Ashby, who uses a wheelchair, was unable to attend the concerts. She sued the School Corporation, alleging discrimination under the Americans with Disabilities Act, 42 U.S.C. 12132, and the Rehabilitation Act. The district court concluded that the Christmas concert was not a “service, program, or activity of” the Warrick Schools, nor was the concert an activity “provided or made available” by the School Corporation and granted summary judgment. The Seventh Circuit affirmed, accepting the Department of Justice’s suggestion that when a public entity offers a program in conjunction with a private entity, the question of whether a service, program, or activity is one “of” a public entity is fact-based and that there is a “spectrum” of possible relationships ranging from a “true joint endeavor” to participation in a wholly private event. The Department’s interpretation of its regulations is a reasonable one that offers a loose but practical framework that aids in decision-making. Upon close examination of the record, it is clear that the event in question was not a service, program, or activity provided or made available by the School Corporation. View "Ashby v. Warrick County School Corp" on Justia Law

Garcia served in the Army from 1952-1954. The military’s records of his medical treatment during service were among those destroyed in a fire in 1973 at the National Personnel Records Center in St. Louis. The record of his medical examination upon leaving the service was not destroyed and reveals a normal psychiatric state and no severe illnesses or injuries. Garcia saw Dr. Smoker, in 1965 for a burn from a welding accident. In 1969, Dr. Smoker diagnosed Garcia with, and prescribed medication for, paranoid schizophrenia. In 2002, Garcia sought disability benefit, alleging service connection of disability-causing paranoid schizophrenia. The regional office denied the claim. The Board of Veterans’ Appeals remanded for a VA psychiatric examination. Although García claimed to have been seen twice for his condition while in service, a VA examiner found it “impossible to say, without resorting to mere speculation, as to whether this veteran’s schizophrenia, paranoid type actually started in Service, without more documentation and records.” The previous denial was “confirmed.” Garcia collaterally challenged the 2006 Board decision, alleging clear and unmistakable error (CUE). The Board and Veterans Court rejected Garcia’s CUE arguments. The Federal Circuit affirmed, upholding the Veterans Court’s application of 38 C.F.R. 20.1409(c) to bar a due process allegation of CUE. View "García v. WIlkie" on Justia Law

The Eighth Circuit affirmed the denial of plaintiff's application for disability insurance benefits and supplemental security income. The court held that good reasons and substantial evidence supported the ALJ's determination that plaintiff's claimed limitations were not entirely credible. In this case, the ALJ considered plaintiff's alleged limitations, and substantial evidence supported the ALJ's residual functional assessment. Finally, the district court properly denied plaintiff's request for another hearing. View "Nash v. Commissioner, Social Security Administration" on Justia Law

Burchett and Jude suffered from serious mental illnesses. Each hired attorney Conn to represent them in applying for Social Security disability benefits, 42 U.S.C. 405(a), which were granted in 2009 and 2010. Conn was perpetrating a fraudulent scheme. Conn paid doctors to submit fraudulent letters concerning his clients' ailments and bribed an ALJ to assign Conn’s cases to his own docket and to decide nearly all of those cases in favor of Conn. Plaintiffs allege that the SSA had reason to suspect Conn's fraud in 2007 due to the reports of internal whistle-blowers. In 2011, the Wall Street Journal published a story about Conn’s exploits. Conn was indicted and pleaded guilty. The Huntington, West Virginia SSA office's former Chief ALJ, pleaded guilty to retaliation against a whistle-blower. The SSA’s Appeals Council informed Jude and Burchett that it was legally required to redetermine their eligibility for benefits (42 U.S.C. 1320a-8(l). Their benefits were suspended pending redeterminations. Each requested additional time to gather evidence. About two weeks after the SSA notices, before the SSA granted those requests, Jude and Burchett each committed suicide. Their estates filed Federal Tort Claims Act (FTCA) claims for wrongful death with the SSA, 28 U.S.C. 1346(b) and 2671, and a Bivens claim alleging procedural due process violations. The Federal Circuit affirmed dismissal of the claims, concluding that the FTCA’s discretionary function exception applied to preclude that claim and that the Bivens claim was improperly formulated. View "Jude v. Commissioner of Social Security" on Justia Law

In this interlocutory appeal from the circuit court’s review of an agency ruling, the Supreme Court adopted the United States Supreme Court’s test for standing as set forth in Lujan v. Defenders of Wildlife, 504 U.S. 555, 560-561 (1992) and held that the existence of a plaintiff’s standing is a constitutional requirement to prosecute any action in the courts of the Commonwealth, including seeking judicial review of an administrative agency’s final order.The putative petitioner in this case, a Medicaid beneficiary (the patient), sought judicial review of a final order of the Kentucky Cabinet for Health and Human Services ruling that the patient lacked standing to pursue an appeal of an insurer’s denial of reimbursement to a hospital for the patient’s services. The hospital, acting as the patient’s representative, sought judicial review of the Cabinet’s final order. The circuit court denied the Cabinet and the insurer’s motions to dismiss the petition. The Supreme Court remanded the case with instructions to dismiss the case, holding (1) Kentucky courts have the responsibility to ascertain whether a plaintiff has constitutional standing to pursue the case in court; and (2) under that test, the patient did not have the requisite constitutional standing to pursue her case in the courts of the Commonwealth. View "Commonwealth v. Sexton" on Justia Law

Pursuant to the terms of Social Security Ruling 00-4p, and in light of the overall regulatory scheme that governs disability claims, the ALJs within the SSA have an affirmative duty to identify apparent conflicts between the testimony of a Vocational Expert (VE) and the DOT and resolve them. The Eleventh Circuit held that this duty requires more of the ALJ than simply asking the VE whether his testimony is consistent with the DOT. The court explained that, once the conflict has been identified, the Ruling requires the ALJ to offer a reasonable explanation for the discrepancy, and detail in his decision how he has resolved the conflict. Furthermore, the failure to discharge this duty means that the ALJ's decision, when based on the contradicted VE testimony, is not supported by substantial evidence.In this case, the ALJ failed to meet his obligations to identify, explain, and resolve an apparent conflict between the testimony of the VE and the DOT on a matter of considerable importance. Accordingly, the court reversed and remanded with instructions. View "Washington v. Commissioner of Social Security" on Justia Law

A social security disability claimant does not have an absolute right to question medical consultants. The Fifth Circuit affirmed the denial of disability benefits to plaintiff, holding that disability claimants' interest in accurate disability decisions was adequately protected by the qualified right to question medical consultants they already enjoyed. The type of case-by-case assessment of need was common for procedural issues in disability cases. In this case, the ALJ did not abuse his discretion by refusing to issue the subpoena or interrogatories at issue. Accordingly, the court affirmed the denial of benefits. View "Barrett v. Berryhill" on Justia Law

The Seventh Circuit affirmed the district court's denial of disability insurance benefits to plaintiff. The court held that substantial evidence supported the ALJ's decision to deny benefits where the opinion's of plaintiff's treating physician were inconsistent with the opinions from other doctors, and the physician's opinions lacked detail and did not show that he knew of the functional capacity evaluation from 2008. Furthermore, the ALJ did not improperly discount plaintiff's own testimony where the ALJ found plaintiff not fully credible for many specific reasons supported by the evidence. View "Hall v. Berryhill" on Justia Law

Robinson served in the Marine Corps in the 1960s, with a deployment in Vietnam. He subsequently experienced heart problems. In 20016, Robinson saw his VA cardiologist, Dr. Sadoughian, who recommended diagnostic testing, but the testing was not performed. Nine months later, Robinson returned after a week in the hospital with blood clots in his leg. Dr. Sadoughian again recommended testing. Robinson received the prescribed testing in April 2007, 14 months after his initial recommendation. The results indicated “[c]oronary artery disease with prior inferior wall myocardial infarction.” In August 2010 the VA amended its regulations to add coronary artery disease to its list of conditions that are presumptively service-connected for veterans who were exposed to certain herbicides, 38 C.F.R. 3.309(e). In 2011, the VA retroactively granted disability benefits to Robinson for that disease following a “Nehmer” review. The Board of Veterans’ Appeals denied Robinson’s claim for an earlier effective date because the April 2007 test results were the earliest medical evidence demonstrating that he satisfied the criteria the disability rating. Robinson argued that he should not be penalized for the delay in scheduling tests and that he would have received an earlier effective date if the VA had provided him with prompt treatment as required by section 17.33(a)(2). The Board concluded that section 17.33 applies only to treatment and has no bearing on effective date criteria. The Veterans Court and Federal Circuit affirmed, noting that the record did not indicate what caused the testing delay or whether Robinson would have satisfied the disability rating requirements earlier. View "Robinson v. Wilkie" on Justia Law